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Experience of miscarriage: an interpretative phenomenological analysis S Meaney,1,2 P Corcoran,1 N Spillane,2 K O’Donoghue2,3

To cite: Meaney S, Corcoran P, Spillane N, et al. Experience of miscarriage: an interpretative phenomenological analysis. BMJ Open 2017;7:e011382. doi:10.1136/bmjopen-2016011382 ▸ Prepublication history for this paper is available online. To view these files please visit the journal online (http://dx.doi.org/10.1136/ bmjopen-2016-011382). Received 3 February 2016 Revised 16 June 2016 Accepted 20 July 2016

ABSTRACT Objective: The objective of the study was to explore the experiences of those who have experienced miscarriage, focusing on men’s and women’s accounts of miscarriage. Design: This was a qualitative study using a phenomenological framework. Following in-depth semistructured interviews, analysis was undertaken in order to identify superordinate themes relating to their experience of miscarriage. Setting: A large tertiary-level maternity hospital in Ireland. Participants: A purposive sample of 16 participants, comprising 10 women and 6 men, was recruited. Results: 6 superordinate themes in relation to the participant’s experience of miscarriage were identified: (1) acknowledgement of miscarriage as a valid loss; (2) misperceptions of miscarriage; (3) the hospital environment, management of miscarriage; (4) support and coping; (5) reproductive history; and (6) implications for future pregnancies. Conclusions: One of the key findings illustrates a need for increased awareness in relation to miscarriage. The study also indicates that the experience of miscarriage has a considerable impact on men and women. This study highlights that a thorough investigation of the underlying causes of miscarriage and continuity of care in subsequent pregnancies are priorities for those who experience miscarriage. Consideration should be given to the manner in which women who have not experienced recurrent miscarriage but have other potential risk factors for miscarriage could be followed up in clinical practice.

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National Perinatal Epidemiology Centre, University College Cork, Ireland 2 Pregnancy Loss Research Group, Dept. of Obstetrics and Gynaecology, University College Cork, Ireland 3 The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland Correspondence to Dr S Meaney; [email protected]

INTRODUCTION Improvements in the quality of care provided during pregnancy have led to substantial reductions in perinatal and maternal mortality as well as a reduction in other adverse pregnancy outcomes.1 However, these advances have had little effect on the high rate of miscarriage with between 20% and 30% of pregnancies ending in miscarriage.1 2 Until now, much of the research has aimed to identify potential risk factors as the underlying aetiology of miscarriage is not well understood.2

Strengths and limitations of this study ▪ This study uses interpretative phenomenological analysis in order to interpret the experience of miscarriage. ▪ Much of the research in relation to pregnancy loss is focused on women’s experience. Purposive sampling was undertaken to ensure that both women’s and men’s experiences were included in this study. ▪ Participants from this study were drawn from a large tertiary maternity hospital with a dedicated pregnancy loss clinic and it may be possible that their experiences may differ from those who attend a hospital where such a clinic is not available to them. ▪ Miscarriage is the most common adverse outcome in pregnancy. This study highlights the need for the provision of appropriate clinical information as well as supportive information when counselling individuals who experienced miscarriage.

Studies indicate the need for familial and social support following miscarriage as it can be an extremely painful and upsetting experience,3 4 with some women experiencing medical complications.5 6 Quantitative studies indicate that the experience of miscarriage can negatively impact on the men’s and women’s psychological well-being.4 7–14 These studies also report that the high levels of stress and anxiety experienced7–9 can endure for 6–12 months following miscarriage.8 In contrast, an interventional study in the USA examined the changes of women’s feeling over the course of year following miscarriage. Swanson et al15 found that women’s responses recorded at 1 year were not significantly different from those recorded at 6 weeks. Considering the high incidence of miscarriage and the reported impact on the emotional well-being of people, there are comparatively few studies that have qualitatively examined the experience of miscarriage. Of these, most studies focused on the

Meaney S, et al. BMJ Open 2017;7:e011382. doi:10.1136/bmjopen-2016-011382

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Open Access women’s experience of miscarriage3 16–18 whereby the male experience has been reported based on the women’s perspective.16 19 Our study builds on these findings as it aimed to explore the experiences of people who have experienced miscarriage. The purpose of this study was to focus on men’s and women’s accounts of miscarriage. Through a qualitative analysis, the objective of the study was to gain detailed insight into their expectations of pregnancy as well as their experience of miscarriage diagnosis and management. METHODS An interpretative phenomenological analysis (IPA) was undertaken as this approach has its theoretical foundations in phenomenology.20–22 Phenomenology examines perceptions and engages with the way individuals reflect on the experiences they deem significant in their lives.21 Researchers who engage in IPA acknowledge how experience is subjective and is therefore only accessible through interpretation.20 IPA has an ideographic approach which allows the researcher to rigorously explore how these experiences may affect a person.20 IPA has increasingly been used in healthcare research as its ideographic approach facilitates researchers to rigorously explore how specific phenomena may affect a patient and consequently will impact on patient care.20 The study took place in a large tertiary-level Irish maternity hospital. The sample was initially recruited from a list of women who had previously participated in a prospective cohort study regarding miscarriage23 and agreed to be contacted for future research. It is important to note that there are geographical variations for the definition of miscarriage. For the purposes of this study, miscarriage was defined as any pregnancy loss which

occurred before 24 weeks gestation in a fetus weighing

Experience of miscarriage: an interpretative phenomenological analysis.

The objective of the study was to explore the experiences of those who have experienced miscarriage, focusing on men's and women's accounts of miscarr...
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